Death with Dignity, Physician-Assisted Death/Dying

Death with Dignity laws allow qualified mentally competent, terminally ill adults to request a prescription medication from their physician for the purpose of hastening their death. Commonly also described as physician-assisted death, physician-assisted dying, aid in dying, or medical aid-in-dying, it is the process that allows terminally ill adults to request from their physician, receive from their pharmacist, and take a lethal dose of medication to end their life. The decision is voluntary and only the person receiving the medication can self-administer it. Death with Dignity laws contain strict eligibility requirements, stringent procedures, and tough safeguards.

The American Academy of Hospice and Palliative Medicine uses the term physician-assisted death “with the belief that it captures the essence of the process in a more accurately descriptive fashion than the more emotionally charged designation physician-assisted suicide.”

(Physician) Assisted Suicide

Language changes so as to respect individuals and their situations. We no longer use certain words that were once acceptable and are now not to identify various people or concepts (children born to unmarried women are no longer referred to as “bastards” or people with physical disabilities as “cripples”). Terminology has changed because these terms were hurtful to the people they identified and perpetuated prejudices against them. This is the case with physician-assisted suicide.

Physician-assisted suicide, or PAS, is an inaccurate, inappropriate, and biased phrase which opponents often use to scare people about Death with Dignity laws. Because the person is in the process of dying and seeking the option to hasten an already inevitable and imminent death, the request to hasten a death isn’t equated with suicide. The patient’s primary objective is not to end an otherwise open-ended span of life, but to find dignity in an already impending exit from this world. They’re participating in an act to shorten the agony of their final hours, not killing themselves; cancer (or another common underlying condition) is killing them.

[A]ssisted suicide is inappropriate when discussing the choice of a mentally competent, terminally ill patient to seek medications that he or she could consume to bring about a peaceful and dignified death.

—American Public Health Association

In recognition of these facts, the State of Oregon stopped using the term “physician-assisted suicide” in 2006. Similarly the American Medical Women’s Association rejects any terms associated with suicide as “inaccurate and inappropriate,” adopting instead “the less emotionally charged, value neutral, and accurate terms ‘aid in dying’ or ‘physician-assisted dying.'” And the American Public Health Association has recognized that the term “assisted suicide” is “inappropriate when discussing the choice of a mentally competent, terminally ill patient to seek medications that he or she could consume to bring about a peaceful and dignified death.”

Journalists and reporters following the Associated Press style guidelines continue to use “physician-assisted suicide” and “medically-assisted suicide” to describe the issue in general. “Aid in dying,” “death with dignity,” or “right to die” are in reference to specific legislation that uses those terms. To be fair, many grapple with the terminology and report on the language battles waged in the media (see examples here, here, and here).

Suicide

Suicide is the act of intentional and voluntary ending of one’s life. Causes of suicide vary and are complex, though a majority of people who die by suicide have a mental illness, especially depression, at the time of their death. Sometimes described as a permanent solution to a temporary problem, suicide ends a life that would otherwise continue.

Physician-assisted dying isn’t suicide legally, morally or ethically. Patients already are dying and therefore are not choosing death over life but one form of death over another.

—Ed Gogol, Final Options Illinois

By contrast, requesting and taking medication under Death with Dignity laws ends a life that is already ending and seeks to hasten the dying process. E. James Lieberman, MD, a George Washington University professor, has written that “terminally ill patients who ask for a doctor’s help in dying are not making the desperate, impulsive choice associated with suicide.”

The distinction is clearly stipulated in Death with Dignity statutes. For example, “Actions taken in accordance with [the Oregon Death with Dignity Act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.”

People using the Death with Dignity laws do not wish to be referred to as suicidal, mentally incompetent, or emotionally depressed. People with a terminal illness do not want to die but are, by definition, dying. They are facing an imminent death and want the option to avoid unbearable suffering and loss of autonomy in their final days.

I’m not committing suicide, and I don’t want to die. I’m not killing myself; bone cancer is taking care of that.

—Jack Newbold

In fact, terminally ill patients who legally access the Death with Dignity Act find the word “suicide” offensive and inaccurate. Many have publicly expressed that the term is hurtful and derogatory to them and their loved ones:

Jack Newbold, a retired sea captain from Astoria, Oregon, told a news conference he resented media reports that he is about to “kill” himself. “I’m not committing suicide, and I don’t want to die. I was upset by media reports that I intend to ‘kill’ myself. I’m not killing myself; bone cancer is taking care of that. I may take the option of shortening the agony of my final hours.”

Charlene Andrews, patient-plaintiff in Gonzales v. Oregon, addressed the National Press Club and attended oral arguments at the US Supreme Court. She pleaded with the media saying, “Please do not call it suicide; that is an insult to my fight against cancer. With cancer we know when there are no treatment options.”

Louise Schaefer, in an op-ed, proclaimed, “All I am asking for is to have some choice over how I die. Portraying me as suicidal is disrespectful and hurtful to me and my loved ones. It adds insult to injury by dismissing all that I have already endured: the failed attempts for a cure, the progressive decline of my physical state, and the anguish which has involved exhaustive reflection and contemplation leading me to this very personal and intimate decision about my own life and how I would like it to end.”

Euthanasia

We not only do not advocate for the legalization of euthanasia, we are actively opposed to it.

Euthanasia refers to the act of deliberately causing the death of another person who may be suffering from an incurable disease or condition, commonly performed with a lethal injection. An injection is never involved under Death with Dignity laws, which require patients to take the medication prescribed under the law themselves.

The Hastings Center defines euthanasia as “the intentional killing of a patient by a physician, as through the physician’s administration of a lethal dose of medication.” According to Free Dictionary, the terms “active euthanasia” and “passive euthanasia” have fallen out of use and “now all euthanasia is generally understood to be active.” However, opponents often call Death with Dignity “passive euthanasia,” a term that has now been replaced with “forgoing life-sustaining treatment.”

Euthanasia is prohibited in Death with Dignity statutes. For example, the Oregon law stipulates: “Nothing in [the Oregon Death with Dignity Act] shall be construed to authorize a physician or any other person to end a patient’s life by lethal injection, mercy killing or active euthanasia.”

The next, most important step in resolving these controversies is to move beyond the issue of whether physician aid-in-dying is suicide and think instead about intentions, about choices, about what range of options we want, what roles we want to be able to play in our own eventual deaths. We know how somebody else’s political or religious beliefs can highjack our options; we need to recognize that somebody else’s language can highjack our options too. If we call it by the most neutral term, “physician assisted dying,” we can reduce much of the tension over matters so important to our own personal futures.